2026/2027 COMSEA PHASE 1 FORM 113 ACTUAL
EXAM QUESTIONS AND DETAILED SOLUTIONS
JUST RELEASED QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT DOWNLOAD
PDF.
• CORE DOMAINS *
•
1. Gross Anatomy, Embryology, and Histology *
•
2. Biochemistry, Genetics, and Molecular Biology *
•
3. Physiology and Pathophysiology *
•
4. Microbiology, Immunology, and Infectious Disease *
•
5. Pharmacology and Therapeutics *
•
6. Behavioral Science, Ethics, and Biostatistics *
•
7. Osteopathic Principles and Practice (OPP/OMT) *
, •
8. Integrated Clinical and Foundational Science Applications *
• INTRODUCTION *
• The COMSAE Phase 1 Form 113 examination is a comprehensive
self-assessment designed for second-year osteopathic medical
students preparing for COMLEX-USA Level 1. It evaluates
foundational biomedical sciences, osteopathic principles, and
clinical reasoning through 176 single-best-answer multiple-choice
questions divided into four sections. The examination assesses
knowledge across anatomy, physiology, pathology, pharmacology,
microbiology, biochemistry, behavioral science, and osteopathic
manipulative medicine. Emphasis is placed on mechanism-based
reasoning, laboratory interpretation, and clinical decision-making.
Successful performance on this formative assessment gauges
readiness for the COMLEX-USA Level 1 and identifies areas
requiring further study. *
SECTION ONE: QUESTIONS 1–100
Question 1
A 28-year-old female presents with acute onset of right lower quadrant
abdominal pain, nausea, and vomiting. On examination, tenderness is
noted at McBurney's point. Which of the following is the most
appropriate next step in management?
A. Computed tomography of the abdomen and pelvis
B. Surgical consultation
C. Oral antibiotics and outpatient follow-up
D. Pelvic ultrasound
, RATIONALE: The presentation is classic for acute appendicitis.
Immediate surgical consultation is indicated for probable appendectomy.
CT may be used but should not delay surgical evaluation. Oral antibiotics
are not first-line for acute appendicitis.
Question 2
A 65-year-old male with a 40-pack-year smoking history presents with
hemoptysis and weight loss. Chest X-ray shows a right hilar mass. Which
of the following is the most specific tumor marker for small cell lung
cancer?
A. Carcinoembryonic antigen (CEA)
B. CA 19-9
C. Neuron-specific enolase (NSE)
D. Alpha-fetoprotein (AFP)
RATIONALE: NSE is a sensitive and specific marker for small cell lung
cancer. CEA is non-specific, elevated in various cancers. CA 19-9 is
associated with pancreatic cancer. AFP is for hepatocellular carcinoma
or germ cell tumors.
Question 3
During a well-child visit, a 4-month-old infant is noted to have poor head
control and persistent fisting of the hands. Which of the following
primitive reflexes should be absent by this age?
A. Moro reflex
B. Palmar grasp reflex
C. Asymmetric tonic neck reflex (ATNR)
D. Rooting reflex
, RATIONALE: ATNR typically integrates by 4–6 months. Persistence
beyond this age suggests neurological impairment. Moro and rooting
reflexes disappear by 3–4 months; palmar grasp by 4–6 months but may
persist slightly longer.
Question 4
A 45-year-old male with type 2 diabetes mellitus presents with a non-
healing ulcer on the plantar aspect of the left foot. The ulcer is
surrounded by callus, and there is no evidence of infection or ischemia.
Which of the following is the most appropriate initial management?
A. Systemic antibiotics
B. Surgical debridement
C. Offloading with a total contact cast
D. Hyperbaric oxygen therapy
RATIONALE: For a non-infected, non-ischemic neuropathic ulcer,
offloading is key. Total contact cast provides effective pressure
redistribution. Antibiotics are not indicated without infection.
Debridement may be needed but offloading is primary.
Question 5
A 72-year-old female with hypertension and osteoporosis presents with
acute onset of severe back pain after lifting a heavy box. She is unable to
stand. On examination, midline tenderness over the L1 vertebra is noted.
Which of the following is the most appropriate initial imaging study?
A. Magnetic resonance imaging (MRI) of the spine
B. Plain radiographs of the lumbar spine
C. Computed tomography (CT) of the lumbar spine
D. Bone scan
EXAM QUESTIONS AND DETAILED SOLUTIONS
JUST RELEASED QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT DOWNLOAD
PDF.
• CORE DOMAINS *
•
1. Gross Anatomy, Embryology, and Histology *
•
2. Biochemistry, Genetics, and Molecular Biology *
•
3. Physiology and Pathophysiology *
•
4. Microbiology, Immunology, and Infectious Disease *
•
5. Pharmacology and Therapeutics *
•
6. Behavioral Science, Ethics, and Biostatistics *
•
7. Osteopathic Principles and Practice (OPP/OMT) *
, •
8. Integrated Clinical and Foundational Science Applications *
• INTRODUCTION *
• The COMSAE Phase 1 Form 113 examination is a comprehensive
self-assessment designed for second-year osteopathic medical
students preparing for COMLEX-USA Level 1. It evaluates
foundational biomedical sciences, osteopathic principles, and
clinical reasoning through 176 single-best-answer multiple-choice
questions divided into four sections. The examination assesses
knowledge across anatomy, physiology, pathology, pharmacology,
microbiology, biochemistry, behavioral science, and osteopathic
manipulative medicine. Emphasis is placed on mechanism-based
reasoning, laboratory interpretation, and clinical decision-making.
Successful performance on this formative assessment gauges
readiness for the COMLEX-USA Level 1 and identifies areas
requiring further study. *
SECTION ONE: QUESTIONS 1–100
Question 1
A 28-year-old female presents with acute onset of right lower quadrant
abdominal pain, nausea, and vomiting. On examination, tenderness is
noted at McBurney's point. Which of the following is the most
appropriate next step in management?
A. Computed tomography of the abdomen and pelvis
B. Surgical consultation
C. Oral antibiotics and outpatient follow-up
D. Pelvic ultrasound
, RATIONALE: The presentation is classic for acute appendicitis.
Immediate surgical consultation is indicated for probable appendectomy.
CT may be used but should not delay surgical evaluation. Oral antibiotics
are not first-line for acute appendicitis.
Question 2
A 65-year-old male with a 40-pack-year smoking history presents with
hemoptysis and weight loss. Chest X-ray shows a right hilar mass. Which
of the following is the most specific tumor marker for small cell lung
cancer?
A. Carcinoembryonic antigen (CEA)
B. CA 19-9
C. Neuron-specific enolase (NSE)
D. Alpha-fetoprotein (AFP)
RATIONALE: NSE is a sensitive and specific marker for small cell lung
cancer. CEA is non-specific, elevated in various cancers. CA 19-9 is
associated with pancreatic cancer. AFP is for hepatocellular carcinoma
or germ cell tumors.
Question 3
During a well-child visit, a 4-month-old infant is noted to have poor head
control and persistent fisting of the hands. Which of the following
primitive reflexes should be absent by this age?
A. Moro reflex
B. Palmar grasp reflex
C. Asymmetric tonic neck reflex (ATNR)
D. Rooting reflex
, RATIONALE: ATNR typically integrates by 4–6 months. Persistence
beyond this age suggests neurological impairment. Moro and rooting
reflexes disappear by 3–4 months; palmar grasp by 4–6 months but may
persist slightly longer.
Question 4
A 45-year-old male with type 2 diabetes mellitus presents with a non-
healing ulcer on the plantar aspect of the left foot. The ulcer is
surrounded by callus, and there is no evidence of infection or ischemia.
Which of the following is the most appropriate initial management?
A. Systemic antibiotics
B. Surgical debridement
C. Offloading with a total contact cast
D. Hyperbaric oxygen therapy
RATIONALE: For a non-infected, non-ischemic neuropathic ulcer,
offloading is key. Total contact cast provides effective pressure
redistribution. Antibiotics are not indicated without infection.
Debridement may be needed but offloading is primary.
Question 5
A 72-year-old female with hypertension and osteoporosis presents with
acute onset of severe back pain after lifting a heavy box. She is unable to
stand. On examination, midline tenderness over the L1 vertebra is noted.
Which of the following is the most appropriate initial imaging study?
A. Magnetic resonance imaging (MRI) of the spine
B. Plain radiographs of the lumbar spine
C. Computed tomography (CT) of the lumbar spine
D. Bone scan
